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Leave Request Form, Non-certified Staff
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Leave Request Form
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Leave Request Form, Non-certified Staff
Today's Date:
*
1. Name of Applicant
*
2. Leave Date(s) Requested
*
3. Site Location
--
Arlington Campus
Gaylord Campus
District Office
Transportation
*
4. Check Proper Leave
--
Sick/Doctor Leave Self
Sick/Doctor Leave Family
Funeral Immediate Family (Spouse, Son, Daughter, Father, Mother)
Funeral Extended Family (Brother, Sister, Grandparents)
Funeral Other Family (Uncles, Aunts)
Funeral Non-Family
Military - Judicial
Personal Leave
Personal Leave No Pay
Staff Development - Must fill out 5 - 10
Vacation
Other
*
Name of Deceased (If funeral is selected)
Relationship to Employee (If funeral is selected)
5. From a.m./p.m. to a.m./p.m.
*
6. Workshop Information
7. Site of Workshop
8. Date and Time of Workshop:
9. Cost of Workshop: Registration Fees
10. Check Payable to:
Is Substitute Needed?
--
Yes
No
If "Yes", Please List Substitute
Send a copy of the completed form to this email address :
*
Indicates Required fields.
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